The tip of the iceberg

We have just seen the highest drug related deaths figures ever; these figures record deaths from drug poisoning, but services providers know that this is just the tip of the iceberg. There is an alarming increase in the numbers of people dying in treatment as a result of chronic ill health.

An aging population of people with drug and alcohol problems are becoming unwell and often receive a poor service from the NHS in relation to their wider health needs because they struggle to navigate an increasingly complex treatment system and are often treated as undeserving by both our health system and local authorities that are under extreme financial pressure.

Imagine that you are living with a completely treatable infection, that left untreated, can cause a life changing illness (for some ultimately death) and the health service said you had to wait until you developed this life threatening related illness before they would treat you. You would rightly be outraged.

This is precisely what is happening to those who have hep C despite a range of new highly effective NICE approved treatments, with few side effects, that offers a cure for hep C. Only 3-4% of people a year currently get treatment. Unless you have a hep C related illness e.g. cirrhosis you are unlikely to be treated and even then it will have to be serious enough. Many of those with hep C who are not deemed ill enough to deserve treatment do not have their condition adequately monitored.   Sadly many GP’s tell me that they monitor those with hep C who appear to be in reasonable health but then suddenly get ill very quickly, with often fatal consequences.

This discrimination happens because around 90% of those with hep C contracted it via injecting drug use. Although many will have contracted hep C many years ago and have moved away from substance misuse they are often treated with suspicion. They are perceived as unreliable patients on whom expensive treatments are not to be wasted. Alongside this those most at risk of spreading hep C to others are seen as chaotic and thus undeserving or unsuitable.

Naloxone is a drug that saves lives by temporarily reversing the effects of opioid drugs. It costs £18 or less per pack and is recommended by the ACMD, WHO, Public Health Ministers and PHE who actively support its wide provision to those at risk of opioid overdose. Despite this many local authorities, including Liverpool, are still refusing to allow treatment providers to distribute it, denying people access to a life saving tool at a time when we are seeing a significant jump in opiate related overdose deaths. Some years ago Liverpool hosted an international harm reduction conference recognising its historical place in the history of harm reduction in drugs services.

In 2014, (after over 34 years of working in the drug, alcohol and criminal justice sectors, and as Blenheim celebrated 50 years of social action) I committed both Blenheim and myself to do everything in our power to ensure that the worlds best evidenced based treatment system was not destroyed by dogma, localism and cuts to public sector finances. Whilst recovery and ending dependency are hugely important we believe harm reduction is equally as important. Some of our sector’s best work is the daily interventions to keep people alive until they are ready to change.

I was concerned then about disinvestment by local authorities in the drug and alcohol treatment sector to fund a wide range of other equally important and underfunded public health priorities. The subsequent cuts and impending disinvestment have exceeded even my most pessimistic view of the future. We face a return to a post code lottery of underfunded services, ill prepared for the next wave of alcohol and drug dependency or to support those in often chronic ill health.

This year, 2016-17, we are seeing a 30% reduction in funding for drug and alcohol services with local authorities facing often impossible challenges, in the current financial climate, in meeting even their statutory responsibilities. With the ring fence coming off the public health grant and its abolition following the proposed introduction of Business Rate Retention, it will become increasingly difficult for local authorities to justify spending on drug and alcohol services when they cannot adequately fund services they are mandated to deliver. There is an urgent need to make the provision of a full range of drug and alcohol treatment services a statutory responsibility for local authorities.

To quote Collective Voice, an organisation part funded by Blenheim along with other large providers:

“Recent reduction in heroin use has been concentrated amongst the under-30s leaving behind a drug treatment population who are increasingly in frail health because of the cumulative impact of decades of drug addiction, problem alcohol use, poor diet, fragile mental health, and smoking. This leaves them significantly more vulnerable than their age would indicate and places a significant burden on mainstream NHS clinical services.

“Despite this, drug and alcohol treatment is not a natural priority for local authorities, the NHS or public health professionals. This places this area of activity at particular risk from the negative consequences of the proposed replacement of the ring-fenced Public Health Grant with a system of business rate retention.

“Drug and alcohol treatment provides for an unpopular and marginalised population seen by local electors, and politicians as undeserving, particularly in comparison to alternative service user populations such as children and the elderly. Without someone in local systems to champion the agenda there is a continuing risk of deprioritisation and disinvestment.”  

There is growing evidence that local politicians feel that drug and alcohol treatment is an NHS function rather than a local authority public health function. Many are already uncomfortable at the proportion of PHE funding to local authorities that is currently spent on drug and alcohol provision.

At Blenheim we work with a wide range of organisations and government departments to fight for drug and alcohol services and to ensure people in treatment aren’t discriminated against. In doing so we are supported at Westminster, by many hard working politicians from all major parties, who help us hold Government to account.

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Shocked and saddened by drug related deaths figures for 2014

At the DAAT conference in early September 2015 I heard the drug related death figures for 2014. Despite having warned people they would be worse than the previous year I was shocked and deeply saddened. I have waited to write this blog to get my thoughts together.

Last year I was shocked by the inaction of Government and many Local Authorities to the 2013 figures.

I was going to talk about the Naloxone Action Group, positive action by the Department of Health, questions in Parliament and early day motions on naloxone. I was going to talk about the fact that since the 2013 drug related death figures came out, I and so many others have worked to try and understand what is happening and the cause.

Personally I believe that increased heroin purity, poor heath and financial pressures on the drug treatment system are key factors in increasing drug related deaths. I also believe that action to increase naloxone availability in England will avert a significant proportion of these deaths. Without naloxone the figures would already have been, in my view, significantly higher.

However the 2014 figures are shocking to me, every death represents a person, perhaps a father or grandmother, certainly someone’s child, grief and the waste of a life. I picture the funerals as a silent rebuke to do more. The figures are the highest since records began.

As you read the statistics below, from the Office of National Statistics, take time to consider the people the figures represent.

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Heroin and morphine deaths rise by two-thirds in the past 2 years.

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Within England, the North East has the highest mortality rate from drug misuse, London the lowest.

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2014 registrations show drug related deaths reaching the highest level since records began.

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Majority of heroin deaths were among the 30-49 year old age groups.

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Males were over 2.5 times more likely to die from drug misuse than females.

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Two issues seemed important to understand after the 2013 figures and they remain the same after the 2014 set. Firstly what is causing the rise in deaths? And secondly what is being done to prevent them?

A naloxone summit, hosted by Blenheim, bought together a campaign for a national naloxone programme in England. Through a FOI request we discovered the true extent of under provision of naloxone with only 32% of local authorities in England saying Naloxone was available. We formed the Naloxone Action Group England to ensure the regulations were changed, to ensure effective guidance was produced, and to ensure provision of naloxone across England. We got MPs to ask a range of questions in Parliament and gained support for an early day motion, sponsored by amongst others the current leader of the opposition Jeremy Corbyn and signed by the current Shadow Chancellor, John McDonald. This was not a party political issue; the EDM was also supported by current Conservative Minister Tracey Crouch. In total 32 MPs signed up to support wider naloxone availability.

Letters to the Minister from the Drug Alcohol and Justice Parliamentary group, chaired by Lord Ramsbotham secured firm assurance that the Government would make the changes recommended by ACMD to make naloxone more widely available from October this year.

Sadly, at the Naloxone Action Group we believe around 50% of local authorities continue to fail to provide naloxone. We will do a further FOI this year.

Meetings at Chatham House with senior officials revealed clear evidence that entering and leaving drug treatment and/or prison are particularly dangerous times for overdose and death. Thus pressure to leave treatment early and failure to adequately manage transfer of those with drug problems from residential settings could seriously endanger lives.

A drug related death summit held at the beginning of this year, hosted by Drugscope, Public Health England (PHE) and the Local Government Association, examined what might be causing the rise and to look at what might be done to reduce overdose deaths in future years. The attendees included policy makers from across government, commissioners, clinical and service provider leaders, and service user representatives.

The key messages from the summit were:

  • The availability of accurate, timely and easily accessible data is important in order to make the appropriate adjustments to policy and practice in order to reduce drug-related deaths;
  • The majority of drug misuse deaths still involve opiates, in particular heroin and methadone;
  • Being in contact with a treatment service would appear to be a significant protective factor for drug-related deaths;
  • Services and practitioners should pay attention to the elevated risk for those in treatment who are regularly overdosing, are drinking excessively, live alone in temporary accommodation or are homeless, or as a result of smoking-related diseases have compromised respiratory systems;
  • Policy makers and commissioners should think about providing timely and accurate alerts to drug users who are not in the treatment system – including drug users who don’t use opiates;
  • Commissioners and services should look at how they could supply naloxone more widely in the community to ensure those vulnerable to heroin overdose (including those not in treatment), their families, peers and carers are able to access the medicine.

Over the last year we have seen PHE nationally, clearly assert the need for action to reduce drug related harm and publish significant guidance on naloxone and reducing drug related deaths. However, at a time when drug related deaths are at their highest ever level, to cut £200million from Public Heath funding to local authorities is truly outrageous.

I am still ashamed to live in a country where things like the PHE £200 million cut happen at a time of evident need and many local authorities look the other way as people die as a result of the negligent failure to follow guidelines and supply naloxone.

It’s time to stand and fight

Disinvestment in drug and alcohol treatment is putting lives at risk.

Blenheim has four strategic aims: number two is to actively and effectively campaign on behalf of people stigmatized by alcohol & drug use. So here goes…

Cuts in drugs and alcohol funding, along with the lack of political leadership, along with a lack of priority in England is having a major negative impact on some of the most vulnerable people in our communities. The moving of drugs funding into Public Health England (PHE), where illicit drug use is not a strategic priority, has given a green light to local authorities to disinvest in substance misuse services.

There has never been a more urgent need to have clear English government leadership spelling out the responsibilities of local authorities along with the levers to ensure they deliver. What we have is localism, a post code lottery, a government washing their hands of responsibility like Pontius Pilate and senior political figures actively conspiring to undermine evidenced based practice. Indeed it is not clear whether under the current Government in England will even have drug and alcohol policies.

We are witnessing the end of the best drug and alcohol treatment system in the world and the time to act to defend it is now. Its decline is being marked by lost opportunities and an increasing death toll as we fail to respond to rapidly increasing numbers of drug related deaths, health needs, and fail to tackle issues such as hepatitis C, HIV and liver disease. We are also failing to resource “harm reduction”, a phrase banished from the Government lexicon like a dirty word.

Over the next 3 years, spending on drug and alcohol services is predicted by some officials to fall between 25% and 50%.

Prior to Drugscope falling victim to Government cuts it’s recently published State of the Sector Report revealed;

  • Evidence of deep and widespread disinvestment and planned disinvestment in drug and alcohol services. (Over 70 services indicating cuts in funding with an average net reduction of 16.5%)
  • A third of local authorities indicating decisions to reduce funding in 2014/15 and 2015/16
  • The massive scale of re-commissioning and tender renegotiation leading to the widespread disruption of services. (54% of services since Sept 13 with another 49% indicating re-commissioning between Sept 14 – Sept 15)
  • Cuts in frontline drug and alcohol staff across the country and increasing caseloads
  • Worsening access to mental health services
  • Worsening provision of outreach services
  • Worsening access to housing and resettlement provision
  • Worsening access to employment support
  • Lack of provision for older clients
  • Negative impact of prison staffing cuts on access to treatment
  • Little confidence in Police and Crime plans and Joint Strategic needs Assessments/Joint Health and Wellbeing strategies reflected local needs
  • Reduction’s in harm reduction services at a time of increases in drug related deaths
  • Commissioning processes that discriminate against excellent small and medium-sized organisations delivering excellent local services

There has been a change in the focus away from the needs of vulnerable heavily addicted people with often multiple economic, social and health problems onto the needs of the wider population. The not insignificant needs of this far larger population will mean fewer resources to support those heavily dependent on drugs and alcohol with multiple and complex needs.

The provision of services to people with significant and multiple needs is being disrupted by frequent re-commissioning and system redesign. It has a hugely detrimental impact on the ability of organisations to care for people accessing services. It has had a significant negative affect on staff morale and the ability of organisations to invest their resources into the provision of services which are increasingly diverted to funding tendering capacity. Sadly at Blenheim, and I suspect other providers, staff work through the night not to help those in need but to win the right to deliver services with significant reductions in funding, challenging targets and poorly thought out PbR requirements. The costs and transfer of liabilities to the voluntary sector are driving all but the largest providers out of existence.

There is an increasing failure to address housing, complex needs, mental health and employment. There is a shocking lack of access to the employment market for people with a history of drug and alcohol misuse particularly where this is associated with criminal convictions. Specialist services addressing employment for this group were decimated in the Government commissioning of the Works Programme. Changes to welfare benefits have impacted detrimentally on housing stability and the level of homelessness experienced by those who are drug and/or alcohol dependent is rapidly increasing. The decommissioning of many NHS providers is resulting in a decline in many areas in access to specialist mental health service provision.

People with drugs and alcohol problems suffer prejudice and discrimination particularly if they commit the crime of being poor. Sadly this right to discriminate is enshrined in UK equality legislation. Yet again we see policies being suggested which focus on drug and alcohol users as being the undeserving benefit claimant if they are not in treatment. A requirement on local authorities to provide employment paying the living wage would be more constructive. It’s often not that people with drugs and alcohol problems are reluctant to work but that employers are reluctant to provide employment. We need a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalizing and stigmatizing people for being ill and vulnerable.

People who inject drugs are the group most affected by hepatitis C in the UK: around 90% of the hepatitis C infections diagnosed in the UK will have been acquired through injecting drug use. Across the UK 13,758 hepatitis C infections were diagnosed during 2013.

Around 2 in 5 people who inject psychoactive drugs such as heroin, crack and amphetamines are now living with hepatitis C, but half of these infections remain undiagnosed. PHE state “Interventions to diagnose infections earlier, reduce transmission and treat those infected need to be continued and expanded, with the goal of reducing the prevalence of hepatitis C.”

Often, hepatitis C infection remains asymptomatic and is only diagnosed after liver damage has occurred. Left untreated hepatitis C infection can result in severe liver damage, liver cancer, liver failure and death.

This year we will leave 97% of people with hepatitis C untreated. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only treat 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone: the failure of Government to roll out Naloxone in England along with a lack of emphasis on harm reduction and disinvestment in drugs services are likely factors in a 32% increase in heroin/morphine related deaths.

The ONS figures (2013) for drug related deaths show that there were 765 deaths involving heroin/morphine; a sharp rise of 32% from 579 deaths in 2012. Many of these fatalities could possibly have been prevented by the use of Naloxone as an intervention.

Naloxone is a medicine that is a safe, effective and with no dependence-forming potential. Its only action is to reverse the effects of opioid overdoses. Naloxone provision reduces rates of drug-related death particularly when combined with training in all aspects of overdose response.

The Advisory Council on the Misuse of Drugs (ACMD) undertook a review of Naloxone availability in the UK in May 2012, its report to the Government strongly recommended that Naloxone should be made more widely available, to prevent future drug-related deaths.

Scotland and Wales have national programmes to make Naloxone widely available but there has been no similar programme in England. This has led to a failure across England to supply Naloxone in over of 50% of local authorities.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight. Perhaps we should conclude that English opiate users lives are worth less than the Welsh and Scottish ones.

There is a growing palpable sense “old school activism” in the sector. There’s no time, no money, no staff, no resource but up and down the country people, organisations and service user groups are rising to the challenge. There is a palpable sense of determination; the power of networking is gearing up, sharing ideas, inspiration and the need to stand strong in the face of cutbacks.

Unless Service User Groups and a powerful alliance of GP’s, NHS and third sector providers and charities are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of local authority cuts, I fear that the worlds best treatment system is about to be decimated in 2015/16. I fear for the people we help and I pray that I am wrong. It’s time to stand and fight.

Tories – England needs you to show strong, inclusive leadership

England has the best drug treatment system in the world; it exists because of the vision of far sighted people from all political parties and the dedication of amazing staff, organisations, charities and public officials over the last 50 years.

Cuts in drugs and alcohol funding, along with the lack of political leadership and the lack of priority in England may in the coming years have a major negative impact on some of the most vulnerable people in our communities.

The moving of drugs funding into Public Health England, where illicit drug use is not a strategic priority, has given a green light to some local authorities to make heart breaking cuts in services, Birmingham being one example.

There has never been a more urgent need to have clear English government leadership matching that of Scotland. Spelling out the responsibilities of local authorities along with the levers to ensure they deliver. I would like the next government to take clear action to protect the best drug and alcohol treatment system in the world. Provide better opportunities for those in recovery and significantly reduce the death toll by committing to harm reduction, responding more robustly to rapidly increasing numbers of drug and alcohol related death and serious illness. I also would like to see a greater emphasis on responding to other health needs of those with drug and alcohol problems.

Any government with an ounce of decency would follow the Portuguese example and move rapidly to bring hepatitis C treatment up to the standards of HIV treatment. If hepatitis C treatment was running trains only 3 in every 100 would get to work and many would die on the platform.

I would like to see the incoming government do the following things with drug and alcohol treatment policy and funding;

  • Identify and appoint a single Senior Government Minister to be responsible for drug and alcohol policy, accountable to Parliament
  • Commit to evidenced-based practice
  • Ensure everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives
  • Develop a national harm-reduction strategy to reduce drug and alcohol related deaths and ill health
  • Widen of the access to residential treatment focusing on need rather than the failure of everything else
  • A minimum unit price for alcoholic drinks is introduced along with health warnings on labels and prominent display of calorie’s
  • Create a national commissioning Ombudsman, to ensure transparency and accountability for local commissioning decisions
  • Widen the remit of the Care Quality Commission (CQC) to include all local authority-commissioned drug and alcohol services
  • Ensure the competence and appropriate accreditation of the drugs and alcohol sector workforce, in line with other areas of health and social welfare, by investing in an independent association
  • Follow the guidance provided by the Advisory Council on the Misuse of Drugs (ACMD)
  • Reinvigorate independent research on drugs and alcohol to fill the gap left by the UK Drug Policy Commission (UKDPC)
  • Ensure comprehensive access to the life-saving drug Naloxone, across the whole of the United Kingdom, in line with World Health Organization (WHO), ACMD and public health guidelines and advice.
  • Ensure the availability of services and National Institute for Health and Care Excellence (NICE) -approved treatments for all patients diagnosed with hepatitis C, in line with international guidelines
  • Everyone in recovery from drug and alcohol problems has opportunities to rebuild their lives,
  • Ensure access to safe and secure housing, employment and meaningful activity and support for health and mental health
  • Investment is provided for a national programme to tackle the stigma and discrimination experienced by people in recovery from drug and alcohol problems
  • ensures expenditure on drugs and alcohol treatment is maintained at a time of severe budgetary pressure on local authorities

“Do not let me die”

At the beginning of last year (2014) I committed Blenheim to campaign on behalf of people with drug and alcohol problems, more specifically for the organisation to campaign around the issues of declining investment in services and the failure to treat those with hepatitis C. By the middle of 2014 I had added the failure to provide access to the life saving drug Naloxone and the need to review drugs legislation to bring it into the 21st century. Interestingly a view shared by a majority of ex Government Ministers responsible for drugs and a significant proportion of ex Chief Constables. Well done Nick Barton the Chief Constable in Durham and Norman Baker MP for daring to say so whilst still in office.

At a time of public sector cuts and funding for drugs and alcohol services delegated to Local Authorities along with a lack of clarity about what they are legally required to provide, there has never been a more urgent need to have clear English government lead spelling out the responsibilities of Local Authorities along with the levers to ensure they deliver. What we have is Localism, a post code lottery and a Government acting like Pontius Pilate. Over the next 3 years spending on drug and alcohol services is predicted, on average, to fall between 25% and 50%.

I and other dedicated determined people have meet with Ministers, MP’s, officials, signed letters of outrage, letters consensus, got questions asked in the House of Lords and the House of Commons and received promises of change and assurances of a Government commitment to action. Thank you to those committed MP’s, Lord’s and Baroness’s who have supported our cause.

Such promises vanish quickly into interdepartmental committees, policy forums and committee sign off, and if all else fails denial of responsibility or power and the words “the funding and responsibility has been devolved we no longer have control and few levers”.

Over the last year there has been a lot of talk, lots of meetings, and little action or change on the ground. There has been little improvement in access to hepatitis C treatment. We still fail to treat 97% of people with this life threatening illness. Imagine the outrage if this was breast cancer or lung cancer, particularly if the death rate was climbing year on year as it is with hepatitis C.  Now imagine if you could completely cure everyone with breast cancer or lung cancer but decided to only cure 3% a year. Outrage! This is precisely what happens to those with hepatitis C.  There is a real risk now that even this appallingly low figure will become unachievable as a result of changes in funding.

Lets move on to Naloxone, I am going to plagiarise an article by Chris Ford and Sebastian Saville, otherwise known as creative swiping (sorry).

What do we do with a medicine that prevents certain death for people with a particular condition—and is safe, cheap, and easy to administer?

  1. Immediately make it accessible to those who can administer it when such a life-or-death situation arises.
  2. Make it available to no one except doctors and emergency room workers.
  3. Endlessly debate the particulars of how and when it should be widely introduced.

If you picked number one that would seem to be a reasonable choice. Unfortunately, it would also be incorrect. With few exceptions, answers two or three apply in the vast majority of the world when it comes to the medicine naloxone.

I was outraged when I heard of a 3 year delay in responding to the ACMD recommendations to make Naloxone more available to families, peers and friends. Blenheim hosted a summit and a wide coalition of agencies and service users formed the Naloxone Action Group (NAG) England. We quickly found a wider scandal of widespread failure across England to supply Naloxone to anyone in over of 50% of Local Authorities.  This is shameful and NAG England will seek to hold authorities accountable.

Overdose remains a leading cause of death among people who use drugs, particularly those who inject. Increasing the availability and accessibility of Naloxone would reduce these deaths overnight.

We await important guidance from PHE on Naloxone, due this month, which local authorities are unfortunately free to ignore unless we give those who are failing to implement a reason to change and somehow hold them to account.

Now this could get depressing and I could go all Shakespeare on you and the following Macbeth quote springs to mind.

“To-morrow, and to-morrow, and to-morrow,

Creeps in this petty pace from day to day

To the last syllable of recorded time,

And all our yesterdays have lighted fools

The way to dusty death.

Out, out, brief candle!

Life’s but a walking shadow, a poor player

That struts and frets his hour upon the stage

And then is heard no more: it is a tale

Told by an idiot, full of sound and fury,

Signifying nothing.”

But last week something amazing happened in Portugal!

“Do not let me die, I want to live” shouted Jose Carlos Saldanha a patient awaiting treatment for hepatitis C, to the Minister of Health during a hearing taking place at a Parliamentary Committee on Health before being escorted from the room.

José Carlos Saldanha was attending several hours of debate on access to treatment for hepatitis C.  He was accompanied by the children of two other patients with hepatitis C one of whom had recently died. Speaking to journalists outside José Carlos Saldanha said that “only in this country, do you see this little shame and that the minister is a “killer” (unfortunately Jose is wrong the same is true in England).

Interviewed on TV the following day José Carlos Saldanha revealed that his treatment had been agreed a year ago and spoke of a “war” that has waged as he struggled to gain access to treatment.

“I am not an imaginary patient, I’m real. The war has been great and my air time is very short. […] There is a cure and I do not understand what they are waiting for.”

This issue has now been a leading political story in Portugal for the last week with the politian’s under fire not only for the failure to supply treatment but for the way in which they initially treated Mr Saldanha and the two people with him.

A week later and Mr Saldanha has started hepatitis C treatment and Portugal is well on the way to putting in place a national programme of treatment for those with hepatitis C.

The extortionate prices of new hepatitis C treatments are also under attack as Medecins du Monde an NGO are challenging the patent on Sofosbuvir with the possibility of dramatic reductions in cost.

Later this month is the DDN Service User Conference, perhaps the time for talking is over, perhaps the time for war is here, and perhaps the time to demand the right to treatment is now. The time to demand “Do not let me die” has arrived.

“We make a living by what we get, but we make a life by what we give.”

As the clock ticks towards the end of 2014 and our 50th year I look back on what has been an amazing year for Blenheim. A new sense of direction, new state of the art central training and management facility, huge investment in upgrading buildings and infrastructure across the organisation and a shift to put the charitable purpose and our beneficiaries even more at the heart of what we do. It has also been the year when we have focused on investing in our capacity to be a business focused highly competitive organisation with the capacity to take on multi-national organisations and win.  Not withstanding this we are determined to work in partnership and support the increasingly threatened smaller providers in our sector.

In a changing landscape for charities Blenheim chooses to say focused on the needs of those with drug and alcohol problems, we choose to focus on the skills of our staff and delivering high quality services, and most of all we choose to stand up for and campaign on behalf of our beneficiaries who are mothers, brothers, sisters and grandparents, work colleagues and friends not just people to be defined and stigmatized by their drug and alcohol use.

Blenheim’s has a proud history based on the work and dedication of its staff and volunteers both past and present. Blenheim has made such a difference to so many lives down the generations. A book “London Calling” documents this history via the memories of current and former service users, staff, volunteers, trustees, and leaders in the drug and alcohol sector.

Throughout 2014 we have actively challenged the stigmatisation of people with drug and alcohol problems by enabling them to tell their moving and humbling stories of recovery, and argue in the corridors of power for a system of regulation that supports those experiencing problems with alcohol and drugs rather than criminalises people for being ill and vulnerable.  In 2015 we will publish a book of 50 recovery stories which shows the impact not just of Blenheim but of the drugs and alcohol sector in the voices of our beneficiaries.

I am appalled at the shameful fact that 97% people with hepatitis C go untreated and that despite a 32% rise in heroin and opiate deaths Naloxone availability (which may have averted some of these) in the England is highly variable with little sense of Government urgency.  Blenheim challenges this clear inequality of care for the people we work with, it is wrong and we will take action. Currently I am chairing the Naloxone Action Group England and Blenheim is a member of both the Hepatitis C Coalition and the London Working Party on Hepatitis C.

As we move forward into 2015 I am determined that Blenheim remains focused on the individual and their holistic needs. The need for friendship, love, employment, somewhere to live, something to eat, support with often deeply troubled lives, and help with a range of physical and mental health problems.

However unless Drugscope along with a powerful alliance of providers are prepared to fight in the corridors of Whitehall and Westminster, and on the beaches of Local Authority cuts I fear that the worlds best treatment system is about to be decimated in April 2015. I fear for the people we help. I fear that commercial self interest will mean as a sector we will walk quietly off the cliff. I am determined that Blenheim will go shouting whilst learning to rock climb or even better fly.

As we enter the next 50 years I am determined Blenheim will continue to dedicate itself to improving the quality of life of people the organisation supports. Everyone deserves a better future.

More naloxone programmes urgently needed

Blenheim and IDHDP were appalled by the alarming 32% increase in opiate-overdose deaths in 2013 in England, so they called a Naloxone Action Summit to see what could be changed to reduce this number of unnecessary deaths.

Globally thousands of lives could be saved by simply increasing opiate users’ access to naloxone. England experienced an alarming 32% increase in opiate-overdose deaths in 2013, totalling 765 in 2013. Blenheim and IDHDP were so appalled by these figures they called a Naloxone Action Summit to see what could be changed to reduce this number of unnecessary deaths. The Summit took place on Monday 27th October and the room was packed with people who wanted to see change happen quickly.

Participants were asked a series of questions before the event and what was clear was there was marked variation of naloxone availability, ranging from nothing to wide available to all. The main barriers to availability appeared to be lethargy, lack of understanding and knowledge, competing priorities, finance and confusion, particularly what you can and can’t do currently. Nationally, the lack of clear guidance or instructions from the centre, confusion about the MHRA consultation, the October 2015 date and funding issues. The main drivers were usually champions in the area with a real desire to reduce these deaths.

The summit got off to a positive start with Professor John Strang of the National Addiction Centre setting the scene and giving a history of naloxone. The evidence has long been available but it took until 1998 for Jersey to provide naloxone to opiate users, but then we had to wait until 2010 to see Scotland launch the first national programme. He then went on to encourage us to do the things we could, like prescribe to all entering  opiate substitute treatment (OST). Professor Strang also stressed the necessity of considering families as a key work-force and highlighted the great importance of normalising use of naloxone. “Why should Naloxone use be any different from the use of insulin, glucagon, the EpiPen or defibrillators?”.

John Jolly reminded us of the ACMD recommendations made in May 2012, which after a review of naloxone said that it should be more widely available in the UK, there should be less restrictions to access and more training is needed. It would appear that saying more training is needed has been used to delay the immediate implementation until after the next election – particularly as training has been going on for sometime now and continues to do so.

Good practice saves lives

Rhian Hills from Wales and Kirsten Horsburgh from Scotland explained how both countries are moving forward with naloxone use. In Wales, as in all places, large numbers of opiate users have witnessed overdoses so clearly a programme was needed. Hills highlighted how since naloxone access programmes were launched in 2010, the overdose deaths decreased 53%.

Kirsten Horsburgh agreed; “the most likely person to witness an overdose is another drug user. So, if the person who uses drugs is carrying naloxone, deaths can be prevented”. Scotland funds the cost of naloxone kits and prioritizes the supply to people who use drugs. They also try to ensure people starting OST have a supply and normalise naloxone provision in services. The training on how to use it is brief (10 minutes is enough!) and they involve peer trainers.

One of the few places in England that has a well established scheme is Birmingham and Dr Judith Yates gave “top tips” on how to get it going e.g. getting on and doing it, prescribing it to all people starting OST, holding naloxone meetings every month, providing training in the management of overdose and in the use of naloxone to all potential first responders (such as hostel workers, families and friends) and making every contact count. “The naloxone experience in Birmingham was not driven and pushed by commissioners, but by doctors, nurses and pharmacists!”, Dr Yates stated enthusiastically.

Kevin Jaffray explained the role of user activism and how they are vital to the process; Elsa Browne discussed the role of training and Kirstie Douse, Head of Legal Services of Release, explained how to use thelegal challenges, such as a judicial review, to improve naloxone access.

Both, during the presentations and after, there were lively discussions, focusing on what can be done now and not getting distracted by what you can’t do. We can prioritise people starting, or on OST, leaving rehab or detox and many other situations where the person could become a patient and have it prescribed to them. Also provision through A+E and prescribing it to all opiate users that access health care for other things. Discussion included how it fitted perfectly into the recovery agenda, how to use PGDs (patient group directives) and PSDs (patient specific directives), how to make training sharp and to the point and involve peer trainers. Very important is to normalise its use in services – “It makes no sense prescribing methadone as a harm reduction measure and not  also prescribing naloxone!” PHE stated that they are planning  to provide guidance to be issued before the end of the year, on what can and should be done  immediately, without waiting for  October 2015.I It was agreed to work with them on that, while also producing a separate clear statements with guidance and advice from the expert members of this group.  This will be helped by the WHO guidance on overdose prevention published on 4th November that completely endorses naloxone.

There is work to be done so a smaller group was formed to take the work forward called Naloxone Action Group – England (NAG – England!). John Jolly CEO of Blenheim was elected as chair. Summing up before leaving one delegate from Penrose put it so well: “It’s a no brainer, training is easy, we need to push the agenda and sort it out!”.

You can see the presentations and more resources on the IDHDP website.